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Travel-related Dengue Virus Infection | CDC EID

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Volume 17, Number 5–May 2011
Travel-related Dengue Virus Infection, the Netherlands, 2006–2007
Gijs G.G. Baaten, Gerard J.B. Sonder, Hans L. Zaaijer, Tom van Gool, Joan A.P.C.M. Kint, and Anneke van den Hoek

Author affiliations: Public Health Service, Amsterdam, the Netherlands (G.G.G. Baaten, G.J.B. Sonder, J.A.P.C.M. Kint, A. van den Hoek); Academic Medical Centre, Amsterdam (G.G.G. Baaten, G.J.B. Sonder, H.L. Zaaijer, T. van Gool, A. van den Hoek); and National Coordination Centre for Traveller's Health Advice, Amsterdam (G.G.G. Baaten, G.J.B. Sonder)

Suggested citation for this article

To assess the incidence of and risk factors for clinical and subclinical dengue virus (DENV) infection, we prospectively studied 1,207 adult short-term travelers from the Netherlands to dengue-endemic areas. Participants donated blood samples for serologic testing before and after travel. Blood samples were tested for antibodies against DENV. Seroconversion occurred in 14 (1.2%) travelers at risk. The incidence rate was 14.6 per 1,000 person-months. The incidence rate was significantly higher for travel during the rainy months. Dengue-like illness occurred in 5 of the 14 travelers who seroconverted. Seroconversion was significantly related to fever, retro-orbital pain, myalgia, arthralgia, and skin rash. The risk for DENV infection for short-term travelers to dengue-endemic areas is substantial. The incidence rate for this study is comparable with that in 2 other serology-based prospective studies conducted in the 1990s .

Dengue virus (DENV) is a flavivirus transmitted through the bite of an infected Aedes spp. mosquito. The disease is endemic to tropical and subtropical regions and each year affects ≈100 million persons worldwide. Most cases are reported from Southeast Asia and Central and South America (1,2).

The incubation period for DENV infection is 3–14 days. Manifestations are nonspecific and range from asymptomatic to severe (3,4). Most infections are benign, with few deaths. In 2%–3% of patients, dengue hemorrhagic fever develops (5).

DENV has 4 distinct serotypes. Primary infection with 1 serotype confers lifelong immunity to that serotype but increases the risk for severe dengue illness after secondary infection with another serotype (6). No specific therapy exists for dengue.

During the past few decades, dengue has emerged in tropical and subtropical countries worldwide (1,7). In addition, the number of reported symptomatic DENV infections among international travelers has increased (5,8,9). This increase may reflect increased incidence of dengue among travelers, increased number of travelers to areas in which dengue is endemic, increased awareness of the disease among physicians, or a combination of these factors.

However, valid research on travelers' risk for DENV infection is scarce. To our knowledge, only 2 prospective studies, performed in the 1990s (10,11), have been conducted. Most other epidemiologic studies are retrospective and focus on symptomatic patients who seek care at a clinical site, thus disregarding the nonspecific nature of the infection and the increased number of travelers to dengue-endemic areas (5,8,9,12,13).

We prospectively estimated the prevalence and incidence of DENV infection and its risk factors. Our findings are based on serologic testing in a cohort of short-term travelers from the Netherlands to dengue-endemic areas.

Travel-related Dengue Virus Infection | CDC EID

Suggested Citation for this Article
Baaten GGG, Sonder GJB, Zaaijer HL, van Gool T, Kint JAPCM, van den Hoek A. Travel-related dengue virus infection, the Netherlands, 2006–2007. Emerg Infect Dis [serial on the Internet]. 2011 May [date cited].


DOI: 10.3201/eid1705.101125

Comments to the Authors
Please use the form below to submit correspondence to the authors or contact them at the following address:

Gijs G.G. Baaten, Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, PO Box 2200, 1000 CE Amsterdam, the Netherlands
; email: gijsbaaten@hotmail.com

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